Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
Cohere Health provides an AI-powered clinical intelligence platform that streamlines access to quality care by improving payer-provider collaboration and cost containment. The company works with over 660,000 providers, handles over 12 million prior authorization requests annually, and has been named to the Inc. 5000 list and a Top 5 LinkedIn Startup for 2023 and 2024.
Analyze and audit inpatient claims for DRG validation, coding accuracy, and clinical appropriateness without a medical record.
Utilize proprietary auditing systems to make determinations and generate audit letters, meeting productivity and quality standards.
Identify new claim types and suggest process improvements while maintaining expert ICD-10 and DRG coding knowledge.
Cotiviti is a healthcare analytics and auditing company that helps payers and providers improve financial performance and clinical outcomes. It is a large organization with a culture focused on accuracy, compliance, and collaboration.
Assign ICD-10-CM, CPT, and E/M codes for hospital-based encounters with high accuracy.
Review clinical documentation to ensure compliance with coding guidelines and payer requirements.
Collaborate with internal teams and client stakeholders while managing multiple assignments.
The partner company provides medical coding services for hospital-based care, ensuring accurate documentation and revenue cycle management. The team emphasizes compliance, accuracy, and a quality-focused culture.
Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records.
Review medical records for DRG/APC assignment, verify charge accuracy, and abstract clinical data.
Collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance.
Logan Health is a growing health system in Northwest Montana that provides quality, compassionate care through connection, service, and innovation. As a healthcare organization, they employ a team-oriented staff and value kindness, trust, collaboration, and excellence.
Review inpatient and outpatient medical records to ensure accurate and compliant clinical documentation.
Collaborate with physicians and clinical teams to clarify diagnoses and support proper coding.
Maintain productivity targets and contribute to provider education initiatives to improve documentation quality.
Jobgether is an AI-powered job matching platform that connects candidates with hiring companies. It processes applications using AI to ensure fair review and shares top candidates with employers.
Auditing claims for medically appropriate services in inpatient and outpatient settings using medical review guidelines.
Documenting findings with reference to appropriate policies and rules.
Generating letters articulating audit findings.
Machinify is a healthcare intelligence company delivering value and efficiency to health plan clients across the US. Deployed by over 85 health plans representing over 270 million lives, the company uses an AI-powered platform and best-in-class expertise to reimagine healthcare cost reduction.
Perform precise coding of telemedicine visits using CPT, ICD-10-CM, and HCPCS Level II codes in compliance with US healthcare standards.
Manage insurance claims processing, including submission, tracking, and resolution of denials or rejections.
Maintain accurate patient billing records and verify insurance eligibility and benefits.
Dr House is a trusted leader in telemedicine, providing high-quality virtual healthcare services across the United States. The company is a dynamic and fast-growing telemedicine firm that seeks to make healthcare more accessible and convenient for patients nationwide.
Review medical records and clinical documentation to ensure accurate, compliant coding per CMS, federal, state, and payer policies.
Conduct routine and focused coding audits, collaborate with clinical leadership and revenue cycle teams, and provide actionable recommendations.
Serve as a subject matter expert on pediatric, Medicaid, telehealth, and behavioral health coding, interpreting state-specific billing requirements.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual and in-home medical, behavioral, and social care, and are a remote-first, high-growth environment.
Support accurate risk adjustment coding by performing first-pass reviews of member medical records.
Maintain compliance with CMS risk adjustment diagnosis coding guidelines and HCC coding standards.
Collaborate with a remote team and contribute to team success through proactive communication and continuous learning.
BlueCross BlueShield of Tennessee is Tennessee's largest health benefit plan company, helping members since 1945. As a remote-first organization, it fosters a culture of innovation and collaboration with a focus on employee well-being.
Evaluates hospital records for diagnostic coding accuracy and clinical documentation alignment.
Conducts DRG validation, readmission, and level-of-care reviews using evidence-based guidelines.
Produces clear clinical summaries and supports utilization management and peer review activities.
The company provides medical record review and utilization management services to ensure accurate coding and appropriate reimbursement. It is a remote-first organization with a focus on clinical integrity and quality assurance.
This advanced inpatient coder codes and abstracts medical records for reimbursement, research, and data analysis.
Uses 3M encoder and demonstrates competency in ICD-10, CPT-4, and HCPCS coding systems.
Meets quality and productivity standards while working in a remote, collaborative environment.
CommonSpirit Health operates over 700 care sites across the U.S., including clinics, hospitals, and virtual care services. With a focus on building healthy communities and advocating for the vulnerable, they employ a supportive, team-oriented workforce.
Serve as an expert in coding guidelines and perform audits to ensure compliance.
Develop and deliver role-specific training and educational materials for coding staff.
Analyze billing/coding behavior and recommend improvements.
UW Medicine is Washington’s only health system with a top-rated medical school and an internationally recognized research center. Nearly 29,000 healthcare professionals, researchers, and educators work within its family of organizations.
Improve first-pass claim acceptance by ensuring correct coding, flagging inconsistencies, and reviewing EOBs and denial trends to identify recurring issues.
Work closely with billing teams and vendors to resolve complex claim issues, review clinical documentation, and support coding corrections and resubmissions.
Ensure compliance with CMS, state Medicaid, and managed-care guidelines while monitoring payer policy changes to optimize coding and billing practices.
ReKlame Health is a clinician-led, tech-enabled provider group providing culturally competent behavioral health and addiction care. As an early-stage organization focused on expanding access to care and health equity, they are building a purpose-driven team dedicated to making a positive impact.
Review and accurately code E/M cases for IP/OP/ER services to maximize reimbursement.
Meet daily production goals and maintain a 95% accuracy rate on a consistent basis.
Stay current on coding guidelines and maintain professional credentials, with flexibility to expand into other specialties.
Alteva RCM helps healthcare providers thrive through expert revenue cycle management and innovative solutions. The company fosters a collaborative culture focused on excellence and professional growth.
Verify and analyze medical records to assign diagnostic and procedural codes using CMS guidelines.
Ensure accurate charge capture and data entry with a 95% accuracy rate.
Serve as a coding resource, resolve discrepancies, and assist in training new staff.
Munson Healthcare is northern Michigan's largest healthcare system with eight community hospitals serving over half a million residents. With a focus on excellence, teamwork, and community, they offer a supportive culture and a lifestyle in a beautiful region.
Review and validate medical codes for accuracy and compliance with ICD-10, CPT, HCPCS, and other coding systems.
Provide expert coding guidance and support to clinicians and departments, serving as a resource for complex coding questions.
Conduct coding audits, generate productivity reports, and collaborate with IT and billing teams to resolve system issues.
Mission Healthcare is a home health and hospice company serving seven states, the largest of its kind in the western United States. They emphasize a culture of compassion, accountability, respect, excellence, and service (CARES) and are committed to diversity and inclusion.
Manages a remote team of behavioral health coding auditors, ensuring audit quality and team performance.
Serves as subject matter expert in behavioral health CPT coding, DSM-5 diagnostic coding, and payer requirements.
Drives operational strategy including capacity planning, staffing, and quality standards for behavioral health audit operations.
Machinify is a leading healthcare intelligence company delivering value and efficiency to health plan clients. Deployed by over 85 health plans, including many of the top 20, and representing over 270 million lives, they offer a flexible and trusting remote work environment.
Perform retrospective and concurrent Quality Assurance audits of inpatient encounters for accuracy and compliance.
Identify areas of educational opportunities and provide feedback to Coding Leadership.
Audit scope includes both government and commercial payors including RAC and ACHA.
Baptist Health is a faith-based, not-for-profit health system providing preventive and specialty care in Northeast Florida through over 200 locations and six hospitals. Recognized as a top workplace and most preferred provider for more than 25 years, it was recently named a top employer for diversity by Forbes.
Lead daily CDI operations, including staffing, workload balancing, and training for clinical documentation improvement.
Conduct real-time clinical reviews for complex cases and analyze data to ensure quality and accuracy.
Collaborate with physicians and staff to enhance documentation quality and compliance with coding guidelines.
Adventist HealthCare is a faith-based, not-for-profit healthcare organization providing comprehensive services including acute-care hospitals, rehabilitation, outpatient centers, and home care. With over 6,000 employees, they are the largest healthcare provider in Montgomery County, Maryland, focused on extending God's care through physical, mental, and spiritual healing.